Medical rehabilitation and health resort treatment in patients with cardiovascular diseases
https://doi.org/10.17749/2949-5873/rehabil.2026.77
Abstract
Background. Cardiovascular diseases (CVD) remain among the leading causes of mortality and disability, thereby underscoring the clinical and socioeconomic relevance of medical rehabilitation and secondary prevention. Cardiac rehabilitation uses a multidisciplinary approach that includes exercise training, modifying risk factors, educating patients, providing psychosocial support, and improving adherence.
Objective: To summarize recent data on effective methods of medical rehabilitation and health resort treatment for CVD patients.
Material and methods. The literature search covered publications between 2014 and 2026 from the PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library and eLibrary databases. Inclusion priority was given to clinical guidelines, systematic reviews, meta-analyses, and randomized controlled trials in Russian and English focusing on cardiac rehabilitation, secondary prevention, telerehabilitation, and health resort treatment for CVD patients. For certain fundamental and methodological provisions, earlier sources (1996–2011) were also used.
Results. The basic principles and stages of cardiac rehabilitation were examined, including the evidence base for exercise training in patients with coronary artery disease and chronic heart failure, as well as those who have undergone percutaneous coronary interventions or coronary artery bypass grafting. Additionally, the feasibility of high-intensity interval and strength training was discussed. Particular attention was paid to health resort treatment as the second stage of rehabilitation within the Russian healthcare system, including balneotherapy, peloid therapy, and climatotherapy; their potential impact on hemodynamics, exercise tolerance, and the psycho-emotional status of CVD patients was thoroughly analyzed. Psychosocial, nutritional, and organizational aspects of rehabilitation were considered, along with the role of telerehabilitation and home-based programs in improving access to care.
Conclusion. Evidence suggests that cardiac rehabilitation improves quality of life and reduces the frequency of hospitalizations and adverse cardiovascular events. Moreover, health resort stage can be considered a significant component of comprehensive rehabilitation, provided that patients are properly selected and the methods used are further standardized.
About the Author
V. V. ShipulinRussian Federation
Vladimir V. Shipulin , PhD
References
1. Timmis A., Vardas P., Townsend N., et al. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J. 2022; 43 (8): 716–99. https://doi.org/10.1093/eurheartj/ehab892.
2. Aronov D.M., Kozlova L.V., Bubnova M.G., et al. Current state and problems of cardio rehabilitation in Russia. Cardiosomatics. 2017; 8 (3): 5–9 (in Russ.).
3. Ambrosetti M., Abreu A., Corrà U., et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021; 28 (5): 460–95. https://doi.org/10.1177/2047487320913379.
4. Edwards K., Jones N., Newton J., et al. The cost-effectiveness of exercise-based cardiac rehabilitation: a systematic review of the characteristics and methodological quality of published literature. Health Econ Rev. 2017; 7 (1): 37. https://doi.org/10.1186/s13561-0170173-3.
5. Shields G.E., Wells A., Doherty P., et al. Cost-effectiveness of cardiac rehabilitation: a systematic review. Heart. 2018; 104 (17): 1403–10. https://doi.org/10.1136/heartjnl-2017-312809.
6. Oganov R.G., Kontsevaya A.V., Kalinina A.M. Economic burden of cardiovascular disease in the Russian Federation. Cardiovascular Therapy and Prevention. 2011; 10 (4): 4–9 (in Russ.). https://doi. org/10.15829/1728-8800-2011-4-4-9.
7. Sinkova M.N., Isakov L.K., Plotnikova E.Yu., Sinkov M.A. Costeffectiveness of complex cardiac rehabilitation of patients with ischemic heart disease, complicated with heart failure, comorbid with type 2 diabetes mellitus. Lechaschi vrach. 2018; 12: 47 (in Russ.).
8. Fesyun A.D., Yakovlev M.Yu., Litvinyuk Ya.A. Prospects for the development of the sanatorium-and-spa industry of the Russian Federation. Problems of Balneology, Physiotherapy and Exercise Therapy. 2020; 97 (4): 52–7 (in Russ.). https://doi.org/10.17116/ kurort20209704152.
9. Razumov A.N., Starodubov V.I., Ponomarenko G.N. (Eds) Sanatoriumresort treatment. National guidelines. Мoscow: GEOTAR-Media; 2021: 752 pp. (in Russ.).
10. Fraser M.J., Leslie S.J., Gorely T., et al. Barriers and facilitators to participating in cardiac rehabilitation and physical activity: a crosssectional survey. World J Cardiol. 2022; 14 (2): 83–95. https://doi. org/10.4330/wjc.v14.i2.83.
11. Brown T.M., Pack Q.R., Aberegg E., et al. Core components of cardiac rehabilitation programs: 2024 update. Circulation. 2024; 150 (1): e32847. https://doi.org/10.1161/CIR.0000000000001289.
12. Aronov D.M., Bubnova M.G. Challenges of the implementation of a new cardiac rehabilitation system in Russia. Russian Journal of Cardiology. 2013; 4: 14–22 (in Russ.). https://doi.org/10.15829/15604071-2013-4-14-22.
13. Miyazawa R., Iso Y., Yamamoto S., et al. Impact of tailored multidisciplinary cardiac rehabilitation on patients with cardiovascular diseases and multimorbidity in convalescent rehabilitation hospitals in Japan a multicenter, prospective observational study. Circ Rep. 2025; 7 (6): 403–10. https://doi.org/10.1253/circrep.CR-24-0137.
14. Telec W., Krysztofiak H., Sowińska A. et al. The long-term benefit of a cardiac rehabilitation program after myocardial infarction the MACAMIS project. A long-term, follow-up, observational study. Kardiol Pol. 2022; 80 (12): 1238–47. https://doi.org/10.33963/KP.a2022.0207.
15. Anderson L., Taylor R.S. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014; 2014 (12): CD011273. https://doi. org/10.1002/14651858.CD011273.pub2.
16. Aronov D.M., Bubnova M.G., Boytsov S.A., et al. Organizational issues of cardiorehabilitation service in Russia. The results of the pilot project “Development of rehabilitation system of cardiovascular patients in medical institutions of Russian Federation entities”. Cardiovascular Therapy and Prevention. 2016; 15 (6): 4–12 (in Russ.). https://doi.org/10.15829/1728-8800-2016-6-4-12.
17. Dibben G., Faulkner J., Oldridge N., et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2021; 11 (11): CD001800. https://doi.org/10.1002/14651858. CD001800.pub4.
18. Kim C., Choi I., Cho S., et al. Do cardiac rehabilitation affect clinical prognoses such as recurrence, readmission, revascularization, and mortality after AMI? Ann Rehabil Med. 2021; 45 (1): 57–70. https://doi.org/10.5535/arm.20080.
19. He X., Wang J., Ye L., et al. Effects of cardiac rehabilitation on cardiac function and cardiovascular adverse events in coronary heart disease patients following percutaneous coronary intervention: a systematic review and meta-analysis of randomized controlled trials. Rev Cardiovasc Med. 2025; 26 (9): 39926. https://doi.org/10.31083/ RCM39926.
20. Miao J., Yang H., Shi R., Wang C. The effect of cardiac rehabilitation on cardiopulmonary function after coronary artery bypass grafting: a systematic review and meta-analysis. iScience. 2023; 26 (12): 107861. https://doi.org/10.1016/j.isci.2023.107861.
21. Subih M., Elshatarat R.A., Sawalha M.A., et al. Exploring the impact of cardiac rehabilitation programs on health-related quality of life and physiological outcomes in patients post coronary artery bypass grafts: a systematic review. Rev Cardiovasc Med. 2024; 25 (4): 145. https://doi. org/10.31083/j.rcm2504145.
22. Gao C., Chen R., Wang R., et al. Effects of high-intensity interval training versus moderate-intensity continuous training on cardiorespiratory and exercise capacity in patients with coronary artery disease: a systematic review and meta-analysis. PLoS One. 2025; 20 (2): e0314134. https://doi.org/10.1371/journal.pone.0314134.
23. Wu Y., Wang H. Optimal doses of high-intensity interval training in patients with coronary artery disease and heart failure: a systematic review and meta-analysis. Front Cardiovasc Med. 2026; 12: 1698310. https://doi.org/10.3389/fcvm.2025.1698310.
24. Wu C., Bu R., Wang Y., et al. Rehabilitation effects of circuit resistance training in coronary heart disease patients: a systematic review and meta-analysis. Clin Cardiol. 2022; 45 (8): 821–30. https://doi. org/10.1002/clc.23855.
25. Molloy C.D., Long L., Mordi I.R., et al. Exercise-based cardiac rehabilitation for adults with heart failure 2023 Cochrane systematic review and meta-analysis. Eur J Heart Fail. 2023; 25 (12): 2263–73. https://doi.org/10.1002/ejhf.3046.
26. Patti A., Merlo L., Ambrosetti M., Sarto P. Exercise-based cardiac rehabilitation programs in heart failure patients. Heart Fail Clin. 2021; 17 (2): 263–71. https://doi.org/10.1016/j.hfc.2021.01.007.
27. Pelliccia A., Sharma S., Gati S., et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021; 42 (1): 17–96. https://doi.org/10.1093/eurheartj/ ehaa605.
28. Fihn S.D., Blankenship J.C., Alexander K.P., et al. 2014 ACC/AHA/AATS/ PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2014; 64 (18): 1929–49. https://doi.org/10.1016/j. jacc.2014.07.017.
29. Anderson L., Oldridge N., Thompson D.R., et al. Exercise-based cardiac rehabilitation for coronary heart disease. J Am Coll Cardiol. 2016; 67 (1): 1–12. https://doi.org/10.1016/j.jacc.2015.10.044.
30. Moini Jazani A., Nasimi Doost Azgomi H., Nasimi Doost Azgomi A., Nasimi Doost Azgomi R. Effect of hydrotherapy, balneotherapy, and spa therapy on blood pressure: a mini-review. Int J Biometeorol. 2023; 67 (9): 1387–96. https://doi.org/10.1007/s00484-023-02512-5.
31. Kamioka H., Nobuoka S., Iiyama J. Overview of systematic reviews with meta-analysis based on randomized controlled trials of balneotherapy and spa therapy from 2000 to 2019. Int J Gen Med. 2020; 13: 429–42. https://doi.org/10.2147/IJGM.S261820.
32. Wang P.C., Chen H.M., Yang L.H., et al. Cardiovascular physiological effects of balneotherapy: focused on seasonal differences. Hypertens Res. 2023; 46 (7): 1650–61. https://doi.org/10.1038/s41440-02301248-4.
33. Shalygin L.D., Kozyrev P.V., Kalinina S.V., Tseev Yu.K. Features of sanitary and resort rehabilitation of patients with coronary heart disease in the climatic conditions of the central part of Russia, who arrived from different regions of the country, taking into account chronobiological approaches and the state of the adaptation system. Bulletin of Pirogov National Medical & Surgical Center. 2023; 18 (3):108–16 (in Russ.). https://doi.org/10.25881/20728255_2023_18_3_108.
34. Islam K.N., Nguyen I.D., Islam R., et al. Roles of hydrogen sulfide (H2S) as a potential therapeutic agent in cardiovascular diseases: a narrative review. Cureus. 2024; 16 (7): e64913. https://doi.org/10.7759/ cureus.64913.
35. Zapolski T., Kornecki W., Jaroszyński A. The influence of balneotherapy using salty sulfide–hydrogen sulfide water on selected markers of the cardiovascular system: a prospective study. J Clin Med. 2024; 13 (12): 3526. https://doi.org/10.3390/jcm13123526.
36. Knyazeva T.A., Estenkova M.G. Adequacy of peloid therapy to the adaptive and reserve capacities of patients with arterial hypertension and concomitant osteoarthritis. Cardiosomatics. 2011; 2 (3): 76–81 (in Russ.).
37. Ezhov V.V. Climate-therapy at seaside resorts in modern medical and wellness practice. Problems of Balneology, Physiotherapy and Exercise Therapy. 2021; 98 (3): 60–6 (in Russ.). https://doi.org/10.17116/ kurort20219803160.
38. Garkavi L.Kh., Kvakina E.B. Principles and methods of health improvement from the standpoint of the theory of nonspecific adaptation reactions of the body. Valeologiya. 1996; 3–4: 5–9 (in Russ.).
39. Kosov V.A., Trebina N.P., Drubachevskaya L.M., et al. The effectiveness of sanatorium rehabilitation of patients with coronary heart disease after myocardial revascularization against the background of postCOVID syndrome. Physical and Rehabilitation Medicine, Medical Rehabilitation. 2022; 4 (2): 111–21 (in Russ.). https://doi.org/10.36425/ rehab108373.
40. Trebina N.P., Kirsanova A.A., Fomenko E.V., et al. Modern medical rehabilitation programs for patients with cardiovascular diseases in the sanatorium and resort support system of the Ministry of Defense of the Russian Federation. Kremlin Medicine Journal. 2025; 2: 46–50 (in Russ.).
41. Ski C.F., Taylor R.S., McGuigan K., et al. Psychological interventions for depression and anxiety in patients with coronary heart disease, heart failure or atrial fibrillation. Cochrane Database Syst Rev. 2024; 4 (4): CD008012. https://doi.org/10.1002/14651858.CD008012.pub4.
42. Wrzeciono A., Mazurek J., Cieślik B., et al. Psychologically-enhanced cardiac rehabilitation for psychological and functional improvement in patients with cardiovascular disease: a systematic review with meta-analysis and future research directions. Physiotherapy. 2024; 125: 101412. https://doi.org/10.1016/j.physio.2024.07.003.
43. Shi W., Ghisi G.L.M., Zhang L., et al. A systematic review, meta-analysis, and meta-regression of patient education for secondary prevention in patients with coronary heart disease: impact on psychological outcomes. Eur J Cardiovasc Nurs. 2022; 21 (7): 643–54. https://doi. org/10.1093/eurjcn/zvac001.
44. Shi W., Ghisi G.L.M., Zhang L., et al. Systematic review, meta-analysis and meta-regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs. 2023; 32 (15–16): 5300–27. https://doi. org/10.1111/jocn.16519.
45. Rees K., Takeda A., Martin N., et al. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2019; 3 (3): CD009825. https://doi. org/10.1002/14651858.CD009825.pub3.
46. Lubrano F., Fucile I., Conte M., et al. Adherence to Mediterranean diet among patients with acute cardiovascular events admitted in Cardiac Rehabilitation unit. Monaldi Arch Chest Dis. 2022; 93 (3). https://doi. org/10.4081/monaldi.2022.2391.
47. Salman A., Doherty P. Predictors of quitting smoking in cardiac rehabilitation. J Clin Med. 2020; 9 (8): 2612. https://doi.org/10.3390/ jcm9082612.
48. Ritchey M.D., Maresh S., McNeely J., et al. Tracking cardiac rehabilitation participation and completion among Medicare beneficiaries to inform the efforts of a national initiative. Circ Cardiovasc Qual Outcomes. 2020; 13 (1): e005902. https://doi. org/10.1161/CIRCOUTCOMES.119.005902.
49. Mathews L., Brewer L.C. A review of disparities in cardiac rehabilitation: evidence, drivers and solutions. J Cardiopulm Rehabil Prev. 2021; 41 (6): 375–82. https://doi.org/10.1097/ HCR.0000000000000659.
50. McDonagh S.T., Dalal H., Armstrong N., et al. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev. 2023; 10 (10): CD007130. https://doi.org/10.1002/14651858.CD007130. pub5.
51. Ramachandran H.J., Jiang Y., Tam W.W.S., et al. Effectiveness of homebased cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis. Eur J Prev Cardiol. 2022; 29 (7): 1017–43. https://doi. org/10.1093/eurjpc/zwab106.
52. Zhong W., Liu R., Cheng H., et al. Longer-term effects of cardiac telerehabilitation on patients with coronary artery disease: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2023; 11: e46359. https://doi.org/10.2196/46359.
53. Scherrenberg M., Wilhelm M., Hansen D., et al. The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2021; 28 (5): 524–40. https://doi.org/10.1177/2047487320939671.
54. Pogosova N.V., Badtieva V.A., Ovchinnikova A.I., Sokolova O.Yu. New treatments and technologies in cardiac rehabilitation programs. Problems of Balneology, Physiotherapy and Exercise Therapy. 2022; 99 (3): 50–7 (in Russ.). https://doi.org/10.17116/kurort20229903150.
55. Harwood A.E., Russell S., Okwose N.C., et al. A systematic review of rehabilitation in chronic heart failure: evaluating the reporting of exercise interventions. ESC Heart Fail. 2021; 8 (5): 3458–71. https://doi. org/10.1002/ehf2.13498.
56. MacEachern E., Quach J., Giacomantonio N., et al. Cardiac rehabilitation and frailty: a systematic review and meta-analysis. Eur J Prev Cardiol. 2024; 31 (16): 1960–76. https://doi.org/10.1093/ eurjpc/zwae239.
57. Bauer T.M., Hou H., Fleigner M., et al. Association between cardiac rehabilitation and 1-year mortality by frailty level in Medicare beneficiaries. Circ Cardiovasc Qual Outcomes. 2025; 18 (12): e012009. https://doi.org/10.1161/CIRCOUTCOMES.125.012009.
58. Tsukakoshi D., Yamamoto S., Takeda S., et al. Clinical perspectives on cardiac rehabilitation after heart failure in elderly patients with frailty: a narrative review. Ther Clin Risk Manag. 2022; 18: 1009–28. https://doi.org/10.2147/TCRM.S350748.
59. Aronov D.M. History of cardiac rehabilitation in Russia. Kardiologiia. 2018; 58 (11S): 14–21 (in Russ.). https://doi.org/10.18087/cardio.2604.
60. Bubnova M.G. Relevant problems of participation and education of patients in cardiac rehabilitation and secondary prevention programs. Cardiovascular Therapy and Prevention. 2020; 19 (6): 2649 (in Russ.). https://doi.org/10.15829/1728-8800-2020-2649.
61. Rangel-Cubillos D.M., Vega-Silva A.V., Corzo-Vargas Y.F., et al. Examining facilitators and barriers to cardiac rehabilitation adherence in a low-resource setting in Latin America from multiple perspectives. Int J Environ Res Public Health. 2022; 19 (4): 1911. https://doi. org/10.3390/ijerph19041911.
62. Ekblom Ö., Cider Å., Hambraeus K., et al. Participation in exercisebased cardiac rehabilitation is related to reduced total mortality in both men and women: results from the SWEDEHEART registry. Eur J Prev Cardiol. 2022; 29 (3): 485–92. https://doi.org/10.1093/ eurjpc/zwab083.
63. Pavy B., Iliou M.C., Meurin P. et al. Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. Arch Intern Med. 2006; 166 (21): 2329–34. https://doi.org/10.1001/archinte.166.21.2329.
64. Stefanakis M., Batalik L., Antoniou V., Pepera G. Safety of home-based cardiac rehabilitation: a systematic review. Heart Lung. 2022; 55: 117–26. https://doi.org/10.1016/j.hrtlng.2022.04.016.
65. McGregor G., Powell R., Begg B., et al. High-intensity interval training in cardiac rehabilitation: a multi-centre randomized controlled trial. Eur J Prev Cardiol. 2023; 30 (9): 745–55. https://doi.org/10.1093/ eurjpc/zwad039.
66. Knyazeva T.A., Grishechkina I.A., Yakovlev M.Yu., et al. Optimising the timing of health resort treatment in patients with arterial hypertension and increased meteosensitivity: a prospective study. Bulletin of Rehabilitation Medicine. 2025; 24 (3): 8–17 (in Russ.). https://doi.org/10.38025/2078-1962-2025-24-3-8-17.
67. Taylor R.S., Dalal H.M., McDonagh S.T.J. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nat Rev Cardiol. 2022; 19 (3): 180–94. https://doi.org/10.1038/s41569-021-00611-7.
Review
For citations:
Shipulin V.V. Medical rehabilitation and health resort treatment in patients with cardiovascular diseases. Journal of Medical Rehabilitation. 2026;4(2):167–178. (In Russ.) https://doi.org/10.17749/2949-5873/rehabil.2026.77
JATS XML
